The Influence Of Intra-articular Injection Of Glucocorticoidss On Blood Glucose Blood Lipids And HPA Axis

Objective:To observe the influence of intra-articular injection of compound betamethasone and dexamethasone palmitate on blood glucose,blood lipids and HPA axis.Methods:60 patients with knee osteoarthritis in our hospital from December 2016 to December 2017,were divided into 4 groups randomly,（n=15each）,including 25 males and 35 females,age between 45 to 70years old.The Body Mass Index were between 18.5³2kg/m²,Visual Analogue Score≥7.All the patients and their families were informed an dsigned informed consent.Group A（compound betamethasone injection 3.5mg）,Group B（compound betamethasone injection 7mg）,Group C（dexam ethasone palmitate 4mg）and Group D（dexamethasone palmitate 8mg）.Each group accepted intra-articular injection,the entry point was at 0.5cm in the back of middle and lower l/3 of patella periphery.After routin e disinfection,put the Puncture needle into tharticular cavityerapidly.If it was hydrarthrosis,took it out firstly,then injected the medicine.Group A was injected with a total of 5ml injection of the Compound betamethas one Injection 3.5mg,2%lidocaine 1ml and 0.9%sodium chloride injecti on.Group B was injected with a total of 5ml injection of the Compound betamethasone Injection 7mg,2%lidocaine 1ml and 0.9%sodium chlo ride injection.Group C was injected with a total of 5ml injection of the Dexamethasone palmitate 4mg,2%lidocaine1ml and 0.9%sodium chl oride injection.Group D was injected with a total of 5ml injection of th e Dexamethasone palmitate 4mg,2%lidocaine 1ml and 0.9%sodium c hloride injection.Record the Visual Analogue Score after injection of eac h group.Record the concentration of morning fasting blood-glucose,blood Total Cholesterol,blood Triglyceride,blood Cortisol and ACTH at eigh t o’clock in the morning,2-hour Postprandial blood Glucose at ten o’cloc k in the morning before injection（T₀）and after injection 2days（T₁）,4d ays（T₂）,6days（T₃）,14days（T₄）and 21days（T5）.All the patients who pa rticipated in the study and their families were informed and signed the informed consent.Results:1.General conditionsThere was no significant difference in age,gender,BMI、VAS in the four groups（P>0.05）.2.The pain remission situationCompared with T₀,the VAS was decreased at T₁,T₂,T₃,T₄,T₅ in each group,there was significant difference（P<0.05）,and there was no significant difference in the four groups（P>0.05）.3.The effect on blood glucoseCompared to T₀,There was no significant difference in FBG at T₁,T₂,T₃,T₄,T₅ in each group（P>0.05）,and there was no significant difference in the four groups（P>0.05）.Compared to T₀,the 2hPG increased at T₁,T₂,T₃,T₄,T₅ in each groups,there was significant difference（P<0.05）,and there was no significant difference at T5（P>0.05）.The 2hPG in group A was higher than Group B,and group C was higher than Group D at T3,there was significant difference（P<0.05）.The 2hPG in group B was higher than Group A,and group D was higher than Group C at T4,there was significant difference（P<0.05）.There was no significant difference between Group A and group C,group B and group D（P>0.05）.4.The effect on blood lipidsCompared to T₀,There was no significant difference in TC and TG at T₁,T₂,T₃,T₄,T₅ in each group（P>0.05）,and there was no significant difference in the four groups（P>0.05）.5.The effect on HPA axisCompared to T₀,the blood Cortisol and ACTH decreased at T₁,T₂,T₃T₄,there was significant difference（P<0.05）,there was no significant difference at T₅（P>0.05）.There was no significant difference in the four groups（P>0.05）.Conclusions:Intra-articularinjectionofbetamethasoneand dexamethasone can effectively relieve the pain caused by knee osteoarthritis,there is no significant influence on FBG,TC and TG,can increase 2hPG and decrease blood Cortisol and ACTH with 2 weeks.